Prospective Analysis of Functional Outcome of Complete Acromioclavicular joint Dislocation Repair Using Double Endobutton Technique.

Manikandan, P (2016) Prospective Analysis of Functional Outcome of Complete Acromioclavicular joint Dislocation Repair Using Double Endobutton Technique. Masters thesis, Tirunelveli Medical College, Tirunelveli.


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BACKGROUND: Numerous procedures have been described for the operative management of acromioclavicular (AC) joint injuries. Some of these techniques, including hardware fixation and non-anatomical reconstructions, are associated with serious complications and high failure rates. In traditional procedures, such as the Weaver-Dunn procedure, the reconstructed coracoclavicular ligament may be much weaker and much more compliant than the native ligament, leading to the reported high failure rate Recently, AC joint reconstruction techniques have focused on anatomical restoration of the coracoclavicular ligaments to achieve optimal clinical outcomes. We used a Double Endobutton technique to separately reconstruct the trapezoid and the coronoid portions of the coracoclavicular ligament. The purpose of this study to evaluate the preliminary clinical and radiological results of this technique in patients with acute complete dislocation of the AC joint. METHODS: This is a prospective study conducted in Tirunelveli Medical College Hospital during the period between july 2014 to September 2015 of 20 cases of complete Acromioclavicular Joint injuries(Rockwood type III-V) treated by reconstruction of coracoclavicular ligaments using Double Endobutton &Mersilene tape, # 5 Ethibond.We had 9 cases of Rockwood type 5, 6 cases of type 4, 5 cases of type 3. We had 6 right sided cases and 14 left sided cases. All injuries opened with vertical strap incision followed by reduction of AC joint and reconstruction done with double endobutton & mersiline tape. All cases are started with pendulum exercises on the first postoperative day.Postop x-ray were taken. Active full shoulder movements, active range of movements were started on 4 weeks. RESULTS: Outcome was measured based on DASH questionnaire and Constant score at intervals of 6, 12, 24 weeks . Radiological assessment was done at intervals of 6, 12, 24 weeks with x-ray shoulder zanca view and x-ray both shoulder AP stress view. Post operative complications was stitch granuloma – 1 case, Shoulder stiffness-1case, superficial infection-1 case.At the last follow-up, 18 patients had an excellent outcome as assessed by Constant score, DASH and Quick DASH scores.One patients had good outcome .one patient had fair outcome. The mean scores at the last follow-up were: Constant score was 96 (range 80 -100), DASH score was 5.3 (range 1-11). CONCLUSION: The AC joint is not a rigid joint. With full overhead elevation, the clavicle rises by up to 35 degrees and rotates on its long axis by 45 degrees. With adduction and extension, it displaces up to 35 degrees anteriorly and posteriorly . Any form of rigid fixation is therefore non-anatomical and will inevitably impair the range of motion of the AC joint. The Endobutton &mersilene device reproduce the course of the conoid & trapezoid portion of the coracoclavicular ligament which is placed in an anatomically correct fashion and providing both vertical&horizontal stability. Endobutton avoids the implant related complications and further surgery to remove the implant. In our series double Endobutton and Mersilene tape has good results of functional outcome and pain free shoulder movements at a mean follow-up interval of 12 months(range, 8–14 months). Excellent reduction of the AC joint was maintained. The Double Endobutton technique is a safe and effective for the treatment of acute complete AC joint dislocations.

Item Type: Thesis (Masters)
Uncontrolled Keywords: AC joint ; CC Ligament ; Endobutton ; Mersilene tape ; #5 Ethibond.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 18 Sep 2017 03:32
Last Modified: 18 Sep 2017 03:32

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